TY - JOUR
T1 - Non-small cell lung cancer
T2 - Prognostic factors in patients treated with surgery and postoperative radiation therapy
AU - Lee, Jason H.
AU - Machtay, Mitchell
AU - Kaiser, Larry R.
AU - Friedberg, Joseph S.
AU - Hahn, Stephen M.
AU - McKenna, Michael G.
AU - McKenna, W. Gillies
PY - 1999/12
Y1 - 1999/12
N2 - PURPOSE: To determine survival outcomes, to identify adverse prognostic factors for relapse, and to compare American Joint Commission on Cancer (AJCC) staging systems in patients with non-small cell lung cancer (NSCLC) treated with surgery and postoperative radiation therapy. MATERIALS AND METHODS: Between 1980 and 1995, 211 patients with NSCLC underwent surgery and postoperative radiation therapy. Surgery consisted of wedge resection (12.5%), lobectomy (67.8%), or pneumonectomy (19.7%). Pathologic stages (1992 AJCC) included I (n = 22), II (n = 70), IIIA (n = 104), and IIIB (n = 12). Indications for radiation therapy included compromised margins (n = 81) and/or positive mediastinal nodes (n = 55). Prognostic factors were identified by using univariate and multivariate models. RESULTS: Overall 3- year survival for patients with stage I, II, and IIIa cancer was 58.9%, 44.1%, and 43.2%, respectively. Older age (P = .008), male sex (P = .021), large primary tumor (P = .004), and multiple positive mediastinal nodes (P = .046) were associated with worse rates of survival. Actuarial risk of local- regional relapse (36 patients) was 21.4% at 3 years. In a multivariate model, use of wedge resection (P = .001), positive margins (P = .010), and larger pathologic tumor (P = .059) were risk factors for local-regional recurrence. Actuarial rate of distant failure was 55.2% at 3 years. CONCLUSION: Local- regional control can be achieved with surgery and radiation therapy in approximately 80% of patients; however, the rate of distant metastasis remains unacceptably high. Other variables, such as multiple positive nodes, may serve to identify patients at higher risk for relapse and poorer survival. Methods for improving treatment outcomes in these patients should be pursued.
AB - PURPOSE: To determine survival outcomes, to identify adverse prognostic factors for relapse, and to compare American Joint Commission on Cancer (AJCC) staging systems in patients with non-small cell lung cancer (NSCLC) treated with surgery and postoperative radiation therapy. MATERIALS AND METHODS: Between 1980 and 1995, 211 patients with NSCLC underwent surgery and postoperative radiation therapy. Surgery consisted of wedge resection (12.5%), lobectomy (67.8%), or pneumonectomy (19.7%). Pathologic stages (1992 AJCC) included I (n = 22), II (n = 70), IIIA (n = 104), and IIIB (n = 12). Indications for radiation therapy included compromised margins (n = 81) and/or positive mediastinal nodes (n = 55). Prognostic factors were identified by using univariate and multivariate models. RESULTS: Overall 3- year survival for patients with stage I, II, and IIIa cancer was 58.9%, 44.1%, and 43.2%, respectively. Older age (P = .008), male sex (P = .021), large primary tumor (P = .004), and multiple positive mediastinal nodes (P = .046) were associated with worse rates of survival. Actuarial risk of local- regional relapse (36 patients) was 21.4% at 3 years. In a multivariate model, use of wedge resection (P = .001), positive margins (P = .010), and larger pathologic tumor (P = .059) were risk factors for local-regional recurrence. Actuarial rate of distant failure was 55.2% at 3 years. CONCLUSION: Local- regional control can be achieved with surgery and radiation therapy in approximately 80% of patients; however, the rate of distant metastasis remains unacceptably high. Other variables, such as multiple positive nodes, may serve to identify patients at higher risk for relapse and poorer survival. Methods for improving treatment outcomes in these patients should be pursued.
KW - Aged
KW - Carcinoma, Non-Small-Cell Lung/mortality
KW - Combined Modality Therapy
KW - Female
KW - Humans
KW - Lung Neoplasms/mortality
KW - Lymphatic Metastasis
KW - Male
KW - Middle Aged
KW - Neoplasm Staging
KW - Pneumonectomy
KW - Prognosis
KW - Radiotherapy, Adjuvant
KW - Retrospective Studies
KW - Survival Rate
UR - http://www.scopus.com/inward/record.url?scp=0032743861&partnerID=8YFLogxK
U2 - 10.1148/radiology.213.3.r99dc23845
DO - 10.1148/radiology.213.3.r99dc23845
M3 - Article
C2 - 10580965
AN - SCOPUS:0032743861
SN - 0033-8419
VL - 213
SP - 845
EP - 852
JO - Radiology
JF - Radiology
IS - 3
ER -